Tarsorrhaphy is a common ophthalmic procedure performed on damaged eyes involving surgical fusion of the upper and lower eyelid margins. The procedure has the effect of partially or fully narrowing the palpebral fissure, thereby reducing exposure of the damaged eye to the external environment, allowing the damaged eye to heal. This procedure is performed most commonly to protect an injured cornea. Examples of conditions which often call for a tarsorrhaphy include keratitis associated with severe dry eyes, non-healing corneal abrasions or ulcers due to any cause, and corneas which are in poor condition immediately following surgical procedures such as corneal transplant, vitrectomy, or glaucoma surgery with the use of antimetabolites, which in themselves are often injurious to the cornea.
The tarsorrhaphy may be one of two varieties. A permanent tarsorrhaphy may be formed wherein the eyelid margins are sealed indefinitely. More common is a procedure known as a temporary tarsorrhaphy wherein the eyelids are fastened together for a time period ranging from six weeks to several months.
Although several techniques exist for performing a temporary tarsorrhaphy, this fundamental procedure implies a surgery that is usually carried out by sewing the top and bottom eyelids together, using a fine suture. The simplest method of creating a tarsorrhaphy is to mark off the opposing areas of the upper and lower eyelids to be fused by means of scratch marks. The eyelids are then sutured together at the marks.
Several problems have been associated with temporary tarsorrhaphies. The sutures used to create the tarsorrhaphy may loosen or pull out before their function is fully accomplished. This may occur in lids whose vitality has been lowered by severe trauma or frequent surgical procedure. This also occurs in lids narrowed congenitally or by loss of tissue due to trauma. Various other techniques have been used in performing a temporary tarsorrhaphy to try to prevent the integrity of the sutures used in performing a tarsorrhaphy from being negatively impacted.
A complex tarsorrhaphy technique has been designed in which a tongue and groove are created in the lower and upper eyelids, respectively, and the tongue is then drawn up to fill the groove in the upper lid and sewn into place. However, in addition to the usual surgical problems associated with sewn-in-place tarsorrhaphies, this method requires more surgery, additional tissue disruption, and may require a longer healing time.
Other techniques also exist for performing a temporary tarsorrhaphy. Small rectangular pieces of material, known as "pegs", may be placed opposite each other on the upper and lower eyelids. The pegs are sewn to the eyelids and then to each other to accomplish the temporary tarsorrhaphy. Although this procedure is of some help in preventing loosening or tearing of the sutures, none of the temporary tarsorrhaphy methods to date have addressed the additional problem of being able to allow the eyelids to be separated in order to visualize the cornea or other parts of the eye without removing the temporary tarsorrhaphy itself.
Although it is possible to sew only a portion of the eyelids together in performing a temporary tarsorrhaphy, this allows only partial protection of the eye and allows only a portion of the eye to be inspected by the ophthalmic practitioner without removing the tarsorrhaphy. Since the purpose of the temporary tarsorrhaphy is to protect the eye and/or to promote healing, it would be advantageous to be able to easily open and reclose the eyelids at will to assess the status of the eye.
Temporary tarsorrhaphies are intended to last for a period of time ranging from six weeks to several months. However, it has been found that by using any of the known methods for a temporary tarsorrhaphy, the tarsorrhaphy can be expected to last a maximum of six weeks. Due to the very thin sutures used to tie the lids together, the sutures have a tendency to pull through or "cheesewire" through the thin tissue of the eyelids. It would be of great advantage if a temporary tarsorrhaphy could be performed which would prevent "cheesewiring", as well as allowing the entire eye to be viewed and allow the eyelids to be easily opened and reclosed without having to re-perform the tarsorrhaphy.